Social determinants of health linked to poorer survival among people with blood cancers
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Several factors contributed to inequities of outcomes among people with hematologic malignancies in the United States, according to findings presented at Society of Hematologic Oncology Annual Meeting.
These factors included health insurance coverage, facility type, education level, household income and marital status.
Survival has improved considerably in recent years for individuals with blood cancers; however, certain disadvantaged populations continue to experience poorer outcomes, including higher mortality.
Prior research has suggested social determinants of health may contribute to inequities in cancer outcomes, according to study background.
Marisol Miranda Galvis, PhD, of Georgia Cancer Center, and colleagues conducted a systematic review to define methodologies used to assess social determinants of health in oncology, and to assess the effect of social determinants of health on outcomes for individuals with hematologic malignancies.
Investigators searched multiple databases and identified 41 eligible studies that included a combined 24,353 patients. Nearly two-thirds (63.4%) of studies were conducted nationally, whereas 19.5% were conducted on a state level and 17.1% were conducted at an institutional level.
The majority of data included in the analysis came from National Cancer Database (41.5%), state databases (19.4%), SEER (17.1%) or medical records (14.6%).
Nearly three-quarters (73.2%) of studies included in the analysis assessed OS, 10.7% assessed early mortality, 8.9% assessed cancer-specific survival, and 7.2% assessed other outcomes such as PFS, DFS or treatment-related mortality.
More than half (53%) of studies explored health care access, 25% explored economic stability, 14.4% assessed education access and 7.6% examined social context. None assessed neighborhood factors.
Results showed an association between social determinants of health and poorer survival. Specific factors linked to worse outcomes included lack of insurance or government insurance; treatment at a nonacademic facility (eg, community cancer center or integrated network cancer programs), treatment at lower-volume facilities, provider expertise (eg, community-based providers or general hematologists/oncologists), being unmarried, lower household income and lower education level.
The findings provide an opportunity to identify underserved patients, Miranda Galvis and colleagues concluded.
Investigators also emphasized the importance of implementing socially targeted interventions to better serve these patients. Those interventions may include expanding access to preventive health care, adopting strategies designed to reduce delays in cancer diagnosis or access to treatment, expanding access to novel evidence-based therapies, implementing shared care models and — specifically for unmarried patients — helping them identify a social network to ensure necessary support.
The results also highlight gaps in the literature, Miranda Galvis and colleagues concluded. These include a lack of individual patient data and a lack of data related to multiple other social determinants of health domains.
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Miranda-Galvis M, et al. Abstract MDS-044. Presented at: Society of Hematologic Oncology Annual Meeting; Sept. 6-9, 2023; Houston.
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